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Eyelid drooping

Ptosis, Dermatochalasis; Blepharoptosis; Third nerve palsy - ptosis; Baggy eyelids

 

Eyelid drooping is excess sagging of the upper eylid. The edge of the upper eyelid may be lower than it should be (ptosis) or there may be excess baggy skin in the upper eyelid (dermatochalasis). Eyelid drooping is often a combination of both conditions.

The problem is also called ptosis.

Causes

 

A drooping eyelid is most often due to:

  • Weakness of the muscle that raises the eyelid
  • Damage to the nerves that control that muscle
  • Looseness of the skin of the upper eyelids

Drooping eyelid can be:

  • Caused by the normal aging process
  • Present before birth
  • The result of an injury or disease

Diseases or illnesses that may lead to eyelid drooping include:

  • Tumor around or behind the eye
  • Diabetes
  • Horner syndrome
  • Myasthenia gravis 
  • Stroke
  • Swelling in the eyelid, such as with a stye

 

Symptoms

 

Drooping of one or both eyelids is present. The lid may cover only the upper eye, or the entire pupil will be covered.

Problems with vision will also be present.

  • At first, just a sense that the very upper field of vision is being blocked.
  • When the drooping eyelid covers the pupil of the eye, the upper part of vision becomes blocked.
  • Children may tip their head back to help them see under the eyelid.
  • Tiredness and achiness around the eyes may also be present.

Increased tearing despite a feeling of dry eyes may be noticed.

 

Exams and Tests

 

When drooping is on one side only, it is easy to detect by comparing the two eyelids. Drooping is more difficult to detect when it occurs on both sides, or if there is only a slight problem.

A physical exam will be done to determine the cause.

Tests that may be performed include:

  • Slit-lamp examination
  • Tension test for myasthenia gravis
  • Visual field testing

 

Treatment

 

If a disease is found, it will be treated. Most cases of drooping eyelids are due to aging and there is no disease involved.

Eyelid lift surgery (blepharoplasty) is done to repair sagging or drooping upper eyelids.

  • In milder cases, it can be done to improve the appearance of the eyelids. 
  • In more severe cases, surgery may be needed to correct interference with vision.
  • In children with ptosis, surgery may be needed to prevent amblyopia, also called "lazy eye."

 

Outlook (Prognosis)

 

A drooping eyelid can stay constant, worsen over time (be progressive), or come and go (be intermittent).

The expected outcome depends on the cause of the ptosis. In most cases, surgery is very successful in restoring appearance and function.

In children, more severe drooping eyelids may lead to lazy eye or amblyopia. This may result in long-term vision loss.

 

When to Contact a Medical Professional

 

Contact your health care provider if:

  • Eyelid drooping is affecting your appearance or vision.
  • One eyelid suddenly droops or closes.
  • It is associated with other symptoms, such as double vision or pain.

See an eye specialist (ophthalmologist) for:

  • Drooping eyelids in children
  • New or rapidly changing eyelid drooping in adults

 

 

References

Davis CM, Dryden RM. Blepharoplasty. In: Tasman W, Jaeger EA, eds. Duane's Ophthalmology. 2013 ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2013:vol 5, chap 74.

Savar A, Blaydon SM, Nakra T, Shore JW. Ptosis surgery. In: Tasman W, Jaeger EA, eds. Duane's Ophthalmology. 2013 ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2013:vol 5, chap 78.

Yanoff M, Cameron D. Diseases of the visual system. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 423.

 
  • Ptosis, drooping of the eyelid

    Ptosis, drooping of the eyelid - illustration

    Drooping of the eyelid is called ptosis. Ptosis may result from damage to the nerve that controls the muscles of the eyelid, problems with the muscle strength (as in myasthenia gravis), or from swelling of the lid.

    Ptosis, drooping of the eyelid

    illustration

    • Ptosis, drooping of the eyelid

      Ptosis, drooping of the eyelid - illustration

      Drooping of the eyelid is called ptosis. Ptosis may result from damage to the nerve that controls the muscles of the eyelid, problems with the muscle strength (as in myasthenia gravis), or from swelling of the lid.

      Ptosis, drooping of the eyelid

      illustration

    A Closer Look

     

      Self Care

       

        Tests for Eyelid drooping

         

           

          Review Date: 8/20/2016

          Reviewed By: Franklin W. Lusby, MD, ophthalmologist, Lusby Vision Institute, La Jolla, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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